I breathe a sigh of relief when I see ideas tossed around in conversation finally show up in print. To support my professional opinions (to myself, to my clients, or to others), it is helpful to refer to something published rather than my fading memory. So I was pleased to see the article "Accompanying a Client on His Therapy Journey" by Pelczarski and Yaruss in an August 2008 issue of Perspectives on Fluency and Fluency Disorders (Vol 18, pp 64-68). Talking about stuttering therapy as a life journey is an analogy one often hears at conventions for SLPs or for persons who stutter. Now here is an article describing that journey.
One task of the SLP as traveling companion is to consult the map often. The SLP is partly a tour guide who constantly wonders: Where are we now? Where have we been? Where are we going next? What do we need to prepare for the next leg of our trip? The novice SLP studies ways to measure different kinds of stuttering, as I once did. He or she has treatments at hand, preferably ones suggested by scientific research and supplemented by ideas from support organizations such as the National Stuttering Association. This is a good start and will get her as far as a single tank of gas will take a car.
Soon, she and the client encounter "bumps in the road," so to speak. The client does not become fluent after a few sessons. In fact, he discovers that "...the work of therapy is what happens in between therapy sessions." (p.65) He must experiment with generalizing skills from the speech therapy room to his life right away. The SLP quickly discovers that her words of wisdom do not yield instant change. Instead, her responsiblities include asking her student about his travels while they were apart. Did he do any 'homework?' If so, he's moved out of his comfort zone and will need meaningful praise and encouragement. In addition, the client's attempts at change will have uncovered additional issues. The SLP can choose which of these she feels comfortable pursuing, if any. She may decide to refer the client to someone else instead, suggesting he find another traveling companion. It's appropriate to take a break from speech therapy to work on other goals.
The experienced clincian will be curious about these detours to pursue other issues and may ask to go along. This SLP knows that progress is about much more than speech sounds. For a brief introduction to this widening scope of practice, an SLP might like to read "Early Intervention: Is Being a Good SLP Good Enough?' by Nancy Keenan-Rich (the ASHAleader online, 2002). Nancy walks the path of family centered therapy. "I had studied family systems and was now seeing first hand how this concept played out in the everyday lives of parents, children, and other caregivers. Family beliefs, values, and priorities became the backdrop for services...parent personalities, stress, boundaries, and the various pressures created by an extended family." (p.1) Nancy became a master at developing relationships and expanding her role to provide "information in areas that do not appear directly related to communcation such as parenting, behavior, and stress." She learned to make room for family input. "How do I collaborate with a parent who is angry with me...?" for example.
The well seasoned SLP, such as myself, has walked down many paths, tripped on her own feet, lost her way, read guidebooks, looked to the stars for direction, retraced her steps, and chatted with many other travelers. :) Therefore, I was delighted to find "Expanding the 'Ports of Entry' for Speech-Language Pathologists: A Relational and Reflective Model of Clinical Practice" by Geller & Foley (American Journal of Speech-Languag Pathology, Vol 18, pp4-21, 2009). This article is for the SLP who knows at the outset that she must invite each client to join her on a long voyage of change. This SLP "does not have a preconcieved agenda, or endpoint" (p.6). She's not even a tour guide. Rather, she comes to the relationship with the expectation that everyone walking participates equally in the travel plans. "...the role of the speech-language pathologist is to form a therapeutic alliance with the client and family in which conditions of safety are created...within this relationship, a range of problems can surface and be explored collaboratively." (p.6) Her role is not to teach nor lead, but to empower. She does not provide direction, but is reflective. "It is the expectation that the process of thinking-in-action, rather than just plowing ahead in implementing concrete goals and procedures, will allow intervention to be more successful." (p.9)
I take my son to piano lessons every week. Last week, I heard the piano teacher ask after students she had taught in the past. "Tell them I said hello," she said to a student finished with his lesson and heading home. In her voice was warm concern and curiousity. I recognized those feelings. I've been an SLP for 26 years and I still wonder about many of my previous students. Some students remain with me in spirit long after we had come to a fork in the road and parted company. I look up at the stars and wish them well.
Judy
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